What happens to our hormones in perimenopause?

One day, your periods become irregular. The next month, you wake up drenched in sweat. Then come insomnia, memory lapses, and the feeling of losing your grip. What if it’s not "stress" but the beginning of a new hormonal phase? Perimenopause affects all women, but few know what's happening in their bodies. It's not a malfunction, nor is it an inevitable fate. It's a transition — powerful, complex, hormonal. So, what's the link between perimenopause and hormones? In this article, we explain what really changes and how to navigate this stage consciously.

Before talking about hormones, what is perimenopause?

Perimenopause is a natural hormonal transition phase in women's lives that precedes the famous menopause. It can begin in the late thirties or early forties, although most of us start feeling its effects around 45. Contrary to popular belief, it's not a sudden event! Instead, it's a gradual process that often spans several years.

During this menopausal transition period, hormonal fluctuations can hit hard. Indeed, the ovaries begin to slow down their hormone production—particularly estrogen and progesterone. But beware: this decline is neither linear nor constant! It occurs in waves, with sometimes unsettling variations. This explains why symptoms can appear irregularly and vary from one woman to another.

Perimenopause is therefore the time when the menstrual cycle begins to become irregular, before menopause (which is the definitive cessation of periods for 12 consecutive months) has set in. Flows become more irregular, sometimes heavier. The length of cycles becomes increasingly spaced out. Some women don't immediately notice this, attributing the first signs of perimenopause to stress, fatigue, or mental overload.

However, what we feel is not "all in our head," but is indeed linked to a hormonal reality. Accepting this phase means allowing ourselves to live it better. And that is an essential first step in this transition in women's lives.

What hormones change during perimenopause and how?

Perimenopause is primarily a hormonal transition. Contrary to the idea of a "dry spell" of hormones, it is more of a gradual imbalance — with highs, lows, and rollercoasters. We explain which main hormones are involved.

Progesterone: the first to decline

The first hormone to kick off hormonal fluctuations? Progesterone. Its decline results in menstrual cycles without ovulation, which become more frequent from the age of forty. However, even if this hormone plays an essential role in regulating the menstrual cycle, it also affects:

• sleep;
• mood;
• emotional stability.

So, inevitably, when it's lacking... We observe:

• heavier periods;
• anxiety;
• severe irritability;
• lighter sleep.

Often, this decline can go unnoticed in standard hormone tests, as progesterone always fluctuates significantly throughout the cycle.

Estrogens: fluctuating

Estrogen levels don't drop suddenly; they fluctuate. Some months, their levels are abnormally high, causing:

• breast pain;
• water retention;
• migraines.

Other times, the decrease in levels is drastic, leading to:

• vaginal dryness;
• night sweats/hot flashes;
• a drop in libido.

In any case, this hormonal transition makes perimenopause bewildering: one month you feel great, the next you're overwhelmed. In short, the body tries to compensate, but... it doesn't always find the right balance!

FSH and LH: the hormones that go haywire

FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are the "orchestrators" of the menstrual cycle. When the ovaries become less responsive, the brain increases their production to restart the process.

The result: their levels soar, sometimes sharply. High FSH levels are indeed an indicator of perimenopause, although they are not sufficient for a diagnosis alone. This is because these hormones do not directly cause symptoms, but they indicate an imbalance or a potential transition phase in progress.

DHEA, testosterone, cortisol: the silent but essential ones

Androgens (like DHEA or testosterone) are less often discussed. Yet, their decline affects women's comfort, particularly:

• their energy;
• their concentration;
• their libido;
• their muscle strength.

Cortisol, the stress hormone, also tends to rise if the body struggles to adapt to all these upheavals. When the endocrine system is under pressure, the body prioritizes stress management at the expense of reproductive functions. This phenomenon, known as "cortisol priority," amplifies fatigue and sleep disturbances.

Quite a hormonal puzzle, isn't it? But understanding it is already a first step, as it allows you to better decode its symptoms and move beyond the idea that "it's all in your head." We repeat: your body is speaking in its own way.

What are the concrete impacts of hormone variations during perimenopause on the body?

While hormones orchestrate perimenopause behind the scenes, their variations have visible—and sometimes overwhelming—repercussions. Beyond irregular periods, the entire body reacts to this transitional phase.

The menstrual cycle becomes unpredictable

The length of periods in perimenopause, that's quite a story! Menstrual cycles lengthen, shorten, disappear for several months, then come back strong. Some women experience heavy bleeding, others vaginal spotting between cycles. In short, it's hard to keep up—and this lack of predictability doesn't help.

Pains, from head to toe

Breast pain (often linked to estrogen surges, as a reminder) can become more frequent. In addition, joint pain may also appear: we rarely identify it as hormonal, and yet, it is definitely present! Some women report morning stiffness or persistent discomfort in their knees, hips, shoulders... In short, we hurt everywhere, and it's not fun.

The urinary and pelvic systems on the front line

Estrogen also influences the tone of pelvic muscles and the elasticity of the urinary tract. The result:

• mild urinary incontinence;
• a feeling of a more fragile bladder;
• more uncomfortable sexual intercourse.

These are some intimate symptoms, rarely discussed, but which weigh heavily on daily life.

The famous "brain fog"

If only perimenopause were just a matter of the body... But no, that would be too easy! Many women also describe experiencing a kind of "brain fog," meaning difficulty concentrating, retaining information, or finding their words. This is not a sign of depression or burnout: it is a very real hormonal manifestation!

A fatigue that goes beyond simple "mental load"

Hormonal fluctuations, disturbed sleep, emotional and physical overstimulation... All of this can lead to deep fatigue, not always relieved by a good night's rest. Some women describe a loss of drive, a need to withdraw, without being able to put words to it.

Invisible risks in the background

This period is also accompanied by an increase in:

• the risks of cardiovascular diseases;
• the risk of fracture;
• and even the risk of cancer.

Nothing automatic, of course! But this transition should be seen as a pivotal moment to take stock of one's overall health, lifestyle habits, and prevention.

Perimenopause: how to support your body and hormones?

Are your symptoms becoming overwhelming? Is your quality of life deteriorating? Don't remain inactive! Because even if perimenopause is not a disease, it may require targeted support. Hormonal treatment or natural alternatives? Here are the options, their benefits, their limitations, and the potential risks to be aware of.

Hormone replacement therapy (HRT)

Still too little known — even dreaded — hormone therapy remains the most effective option for relieving symptoms such as:

• hot flashes;
• night sweats;
• sleep disturbances;
• or genitourinary syndrome (discomfort during intercourse, dryness, recurrent infections, etc.).

It generally relies on hormonal substitution: estrogens alone or combined with progesterone, depending on the case. It can be administered orally, transdermally (patch, gel), or vaginally (ovules, cream, vaginal ring).

The most recent studies (including that by Manson JE within the framework of the Women’s Health Initiative) have helped to nuance fears related to the risk of cancers and cardiovascular diseases. How? By showing that these risks depend mainly on:

• the age at which treatment is initiated;
• the treatment regimen;
• and health history.

Hence the importance of a personalized approach that assesses the benefit-risk for each woman.

Alternative and complementary treatments

Some women cannot—or do not want to—resort to hormone replacement therapy. And we understand them. In this case, other solutions can help relieve the symptoms of perimenopause:

• herbal supplements (black cohosh, sage, red clover, maca, etc.);
• phytoestrogens, accompanied by medical follow-up;
• targeted micronutrition;
• low-dose antidepressant treatment (sometimes prescribed for mood or sleep disorders);
• relaxation techniques (yoga, breathing exercises, heart coherence, etc.).

Be careful: natural does not mean harmless! We advise you to always seek medical advice, especially in cases of a family history of hormone-dependent cancers or venous thrombosis.

The importance of lifestyle

Whether there is treatment or not, lifestyle habits play a central role during this period. Regular physical activity helps to:

• protect blood vessels;
• preserve bones (and limit the risk of fracture);
• balance cortisol.

Also, try to adopt a balanced diet. This will help you better manage your caloric intake and avoid the decrease in energy expenditure typical of this phase.

Of course, let's not forget emotional support, which is crucial during these years of transition!

In short, perimenopause marks an important hormonal transition in women's lives — sometimes silent, often bewildering, but never insignificant. Understanding its mechanisms and recognizing its signs is already regaining power over this period! Because no, it's not "all in your head." It's in your body, in your hormones, and you have the right to be informed, supported, and accompanied.